title: A prospective evaluation of iron deficiency anemia in the GI endoscopy setting: role of standard endoscopy, videocapsule endoscopy, and CT-enteroclysis.
abstract: BACKGROUND
  Iron deficiency anemia (IDA) is a frequently encountered condition in clinical practice. After conventional endoscopy, the cause of anemia remains unknown in up to 40% of patients.
  
  
  OBJECTIVE
  To evaluate prospectively the diagnostic efficacy of a systematic endoscopic approach to IDA and to compare the diagnostic yield of videocapsule endoscopy (VCE) and CT-enteroclysis in endoscopy-negative patients.
  
  
  METHODS
  Consecutive patients with IDA were enrolled prospectively.
  
  
  METHODS
  Open-access endoscopy within an academic hospital.
  
  
  METHODS
  This study involved 189 patients with IDA, including 98 women and 91 men; mean (±standard deviation) age 68 years±16.6 years.
  
  
  METHODS
  Patients with IDA underwent gastroscopy and colonoscopy plus ileoscopy. Endoscopy-negative patients were further blindly evaluated by both CT-enteroclysis and VCE.
  
  
  METHODS
  Diagnostic yield of conventional endoscopy; diagnostic yield of VCE versus CT-enteroclysis.
  
  
  RESULTS
  Endoscopy results were positive in 144 of 189 patients (76.2%). CT-enteroclysis and VCE allowed a diagnosis in 37 of 45 endoscopy-negative patients (82.2%). Overall, VCE was superior to CT-enteroclysis (77.8% vs 22.2%; P<.001), in particular when flat lesions were found.
  
  
  CONCLUSIONS
  Single-center study.
  
  
  CONCLUSIONS
  A systematic approach to IDA, which includes standard endoscopy, VCE, and CT-enteroclysis allows an overall diagnostic rate of 95.7%; however, CT-enteroclysis should be limited to cases of nondiagnostic VCE.
authors.affiliation: Department of Medicine and Aging Sciences, Section of Internal Medicine and Gastroenterology and Center for Excellence on Ageing (Ce.S.I.), G.D'Annunzio University and Foundation, Chieti, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Milano
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Balatsinou
authors.forename: Antonella
authors.initials: A
authors.lastname: Filippone
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Caldarella
authors.forename: Francesco
authors.initials: F
authors.lastname: Laterza
authors.forename: Domenico
authors.initials: D
authors.lastname: Lapenna
authors.forename: Sante Donato
authors.initials: SD
authors.lastname: Pierdomenico
authors.forename: Fabio
authors.initials: F
authors.lastname: Pace
authors.forename: Franco
authors.initials: F
authors.lastname: Cuccurullo
authors.forename: Matteo
authors.initials: M
authors.lastname: Neri
mesh_terms: D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis* / Q000209:etiology; D053704:Capsule Endoscopy / Q000379:methods*; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000175:diagnosis; D005773:Gastroscopy / Q000379:methods*; D006484:Hemorrhoids / Q000150:complications / Q000175:diagnosis; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*